COVID-19 Is No Longer a Public Health Emergency: Implications for Patients and Clinicians
Authors: Christine Laine, Darilyn V. Moyer
Journal: Annals of Internal Medicine (2023)

Special Articles23 May 2023COVID-19 Is No Longer a Public Health Emergency: Implications for Patients and CliniciansFREEChristine Laine, MD, MPH and Darilyn V. Moyer, MDChristine Laine, MD, MPHEditor in Chief, Annals of Internal Medicine (C.L.)Search for more papers by this author and Darilyn V. Moyer, MDExecutive Vice President and Chief Executive Officer, American College of Physicians (D.V.M.)Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/M23-1338 Eligible for CME Point-of-CareCME/MOC SectionsAboutVisual AbstractPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Thankfully, the darkest days of the COVID-19 pandemic appear to be behind us. We are in a much better place today than at any time in the past 3 years as evidenced by both the United States and the World Health Organization recently declaring that COVID-19 is no longer a public health emergency. But that does not mean we can forget about the virus.On 19 May 2023, Annals of Internal Medicine and the American College of Physicians assembled a panel of experts in public health and infectious diseases to discuss the COVID-19–related challenges that remain for clinicians and patients. Panelists included Ashish K. Jha, MD, MPH, the White House Coordinator of the COVID-19 Response; Roger Bedimo, MD, Professor in the Department of Internal Medicine at UT Southwestern Medical Center and Infectious Diseases Section Chief at the VA North Texas Health Care System; and Carlos del Rio, MD, the Leon L. Haley Jr. MD Distinguished Professor of Medicine in the Division of Infectious Diseases at Emory University School of Medicine and Interim Dean at Emory University School of Medicine. Michael J. Tan, MD, moderated the discussion. Dr. Tan is Professor of Internal Medicine at NEOMED, lead physician for Summa Health Medical Group–Infectious Disease, and Assistant Medical Director at SummaCare. Video of this program is available at Annals.org.Video. ACP/Annals Forum - COVID-19 Is No Longer a Public Health Emergency: Implications for Patients and Clinicians The ACP/Annals forum, COVID-19 Is No Longer a Public Health Emergency, held on 19 May 2023, features speakers Roger Bedimo, MD; Carlos del Rio, MD; Ashish K. Jha, MD, MPH; and Michael Tan, MD. (Duration 1:24:48)The program began with Dr. Jha explaining what the end of the public health emergency means. The White House declared COVID-19 a public health emergency in 2020 to enable actions to help the U.S. health system cope with the burden of caring for many thousands of Americans affected by COVID-19 while maintaining other essential health services. The declaration was lifted on 11 May 2023 because health systems no longer need emergency tools to cope. While approximately 150 COVID-19–related deaths still occur daily in the United States, the system ably handles the volume of persons requiring hospital services. The end of the public health emergency will not affect the status of drugs and vaccines that have emergency use authorization. COVID-19 vaccines and therapies will remain free to persons who need them until depletion of the U.S. stockpile, which Dr. Jha predicted will happen in fall 2023. Dr. Jha expressed confidence that when people need to turn to public and commercial insurers to cover COVID-19 vaccines and therapies, they will be covered completely or with low out-of-pocket costs. He was confident that the U.S. Department of Health and Human Services' (HHS) programs will provide access to persons without health insurance and that Project NextGen will yield preventive and therapeutic advances. Based at HHS with a $5 billion investment, Project NextGen is coordinating the federal government and the private sector to develop new vaccines and therapeutics.After Dr. Jha's presentation, Dr. Bedimo and Dr. del Rio discussed 2 clinical scenarios—one concerning COVID-19 testing and the other vaccination. The testing scenario presented a healthy, nonelderly, fully vaccinated adult who developed upper respiratory symptoms and posed the question of whether testing for COVID-19 when symptoms occur is required now that we are no longer in a public health emergency. Dr. Bedimo leaned toward testing for COVID-19, and also for influenza if the scenario occurred during influenza season, so that the person could implement appropriate measures to prevent transmission to others. Dr. del Rio leaned toward no testing, noting that this healthy, nonelderly patient was not a candidate for COVID-19 therapy and, regardless of the cause of the upper respiratory symptoms, the patient should stay home and isolate from others. He noted that testing is inconvenient and potentially costly, particularly as free tests become unavailable, so tests should be done only when the results will change management. The panelists agreed that the decision to test or not to test should consider both patient factors and context, such as community infection rates and whether the symptomatic person resides with others at risk for poor outcomes should they contract COVID-19.The second clinical scenario addressed when a fully vaccinated person who is younger than 65 years and without immunocompromise should receive another dose of vaccine. The panelists agreed that such a person does not need additional vaccination at this time. Vaccination might be warranted when a new vaccine formulation becomes available, which they predicted might be in fall 2023. The Centers for Disease Control and Prevention currently recommends a single dose of the bivalent vaccine for previously unvaccinated, low-risk persons. More than 80% of the U.S. population is not fully vaccinated, so it is imperative for front-line clinicians to try to motivate vaccination and counter the misinformation that has stymied vaccine efforts to date.A question-and-answer session raised many practical issues. Vaccination after acute infection in previously unvaccinated persons should occur 10 to 12 weeks after recovery. Dr. del Rio advised thinking about masks like umbrellas—a tool that we use based on risk. COVID-19 is not a seasonal illness, so vaccination need not be seasonal except for the convenience of pairing it with influenza vaccination. The decision to use antiviral therapy should depend not on severity of symptoms but on a person's risk for severe disease. Every infected person aged 65 years or older, or those with an underlying immunocompromising condition, should receive antivirals regardless of their symptom severity at presentation. We sorely need information about the risks for and management of persistent symptoms after acute SARS-CoV-2 infection.The public health emergency has ended, but COVID-19 remains with us. Nearly all COVID-19–related hospitalizations and deaths currently occur in people who are not fully vaccinated and have not received early treatment. Reducing hospitalizations and deaths will require ongoing action by front-line clinicians to increase rates of vaccination and prescription of therapy when indicated. Clinicians and the public must adjust to the current situation and be prepared to shift should this crafty virus evolve yet again. Comments0 CommentsSign In to Submit A Comment Imran NaqviMyself22 May 2023 Vaccination requirements Based on the CDC's data, current and coming variants will likely continue to be more infectious yet significantly less virulent. What is then the purpose of mandating requirements for healthcare facilities? A prior unvaccinated individual cannot get a job in a hospital unless they are vaccinated. Please provide citations to the benefit of vaccinations or boosters based on the current variants. Thank you. Emelita CoHPH23 May 2023 Covid-19 vaccine Encourage vaccination but not mandate, several had complete vaccine including 3rd dose but got severe infection. Covid vaccine needs further study and politics should be out of it. Author, Article, and Disclosure InformationAuthors: Christine Laine, MD, MPH; Darilyn V. Moyer, MDAffiliations: Editor in Chief, Annals of Internal Medicine (C.L.)Executive Vice President and Chief Executive Officer, American College of Physicians (D.V.M.)Disclosures: All relevant financial relationships have been mitigated. Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M23-1338.Editors' Disclosures: The editors have no relevant financial relationships to disclose. Individual forms may be viewed at www.annals.org/editorsdisclosures.Corresponding Author: Christine Laine, MD, MPH, Editor in Chief, Annals of Internal Medicine, 190 N. Independence Mall West, Philadelphia, PA 19106; e-mail, [email protected]org.This article was published at Annals.org on 23 May 2023. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoCOVID-19 Vaccine: What Physicians Need to Know Christine Laine , Deborah Cotton , and Darilyn V. 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